2. Tests for secondary breast cancer in the bone

X-ray of the bone

An x-ray can show changes in the bone. The x-ray may not be able to pick up small areas of cancer.

Bone scan

A bone scan checks the whole skeleton. It can help identify changes to the bone caused by injury, healing or disease such as cancer.

A small amount of radioactive substance is injected into a vein, usually in the arm, two to three hours before the scan. This helps identify if there’s been a change in the bones (often called a ‘hot spot’).

Bone biopsy

In most cases your specialist will be able to tell if you have secondary breast cancer in the bone from your symptoms and scans. However, in some cases a biopsy can help confirm the diagnosis and decide what treatment may help.

A biopsy involves taking a small piece of bone to be examined under the microscope. This may be done using local or general anaesthetic.

3. Tests for secondary breast cancer in the lungs

Chest x-ray

A chest x-ray is often the first investigation that will be done to see if there is secondary breast cancer in the lungs.

Lung biopsy

Sometimes a biopsy of the lung is taken. This involves removing a small piece of tissue from the lung, usually while you are sedated, to be looked at under a microscope. If you have a build-up of fluid in the space around the lungs (pleural effusion), a sample of fluid can also be taken for testing.

Bronchoscopy

The most common procedure for taking a lung biopsy is a bronchoscopy. A tube called a bronchoscope is passed through the mouth and down into the lungs. A small piece of lung tissue can then be removed and examined under a microscope.

CT-guided lung biopsy

Sometimes a biopsy can be taken from the lung through the skin with a needle using a CT scan for guidance.

EBUS (endobronchial ultrasound)

This test involves passing an ultrasound probe attached to a bronchoscope into the lungs. It allows the doctor to see the lungs and lymph nodes and take a sample of tissue if required. EBUS is a relatively new test so is not yet widely available.

4. Tests for secondary breast cancer in the liver

Ultrasound scan

An ultrasound scan uses high-frequency sound waves to produce an image of the liver to show any abnormalities.

Liver biopsy

In most cases your specialist will be able to tell if you have secondary breast cancer in the liver from your symptoms and scans.

However, in some cases it can be useful to have a biopsy taken. This involves removing a small piece of tissue from the liver, under local anaesthetic, to be examined under a microscope. An ultrasound is usually used to guide the procedure. You will need to stay in hospital for a few hours after the liver biopsy because of the risk of bleeding.

5. Tests for secondary breast cancer in the brain

Neurological examination

A neurological examination is a series of simple tests that provide information about the nervous system.

Your specialist may look in your eyes with an instrument called an ophthalmoscope to see if there is swelling at the back of the eyes caused by pressure from the brain. They may check your arms and legs for changes in feeling and strength, and changes in your reflexes. They may look at your balance and how you are walking.

Brain biopsy

In most cases your specialist will be able to tell if you have secondary breast cancer in the brain from your symptoms and scans, but occasionally it’s necessary to have a biopsy.

This involves removing a small piece of tissue from the brain, under general anaesthetic, to be examined under a microscope.

6. Tests for secondary breast cancer in the skin

Punch biopsy

To confirm a diagnosis of secondary breast cancer in the skin, a punch biopsy may be performed.

You’ll be given a local anaesthetic before a tiny cutter device is used to take a very small piece of tissue from the area. It’s not unusual for the area to bleed a little after the biopsy so you’ll usually be given a small dressing or plaster afterwards.

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